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Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa. | LitMetric

AI Article Synopsis

  • The study aimed to assess the effectiveness of various diagnostic tools for detecting diabetes in patients recently diagnosed with pulmonary tuberculosis across four middle-income countries.
  • It involved recruiting 2,185 patients and comparing different tests' accuracy, with point-of-care HbA1c and a specific risk score showing the highest reliability for diagnosis.
  • The conclusion suggested that a two-step testing approach using random plasma glucose and point-of-care HbA1c can accurately identify diabetes in these patients, highlighting the need for further validation of risk scores.

Article Abstract

Objective: To evaluate the performance of diagnostic tools for diabetes mellitus, including laboratory methods and clinical risk scores, in newly-diagnosed pulmonary tuberculosis patients from four middle-income countries.

Methods: In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen initial random plasma glucose was ≥ 6.1 mmol/L.

Findings: The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6-14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75-0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81-0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru.

Conclusion: Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemia, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6239004PMC
http://dx.doi.org/10.2471/BLT.17.206227DOI Listing

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